The children cry in their hospital beds, as doctors in protective clothing try to make life as comfortable as possible for them. Some of the patients are only one or two years old. Some have severe acute respiratory syndrome (Sars), others are suspected cases. The most unfortunate have - although they do not know it yet - already lost their parents to the disease. Among the dedicated doctors at Hong Kong's Princess Margaret Hospital who daily help these young victims of Sars is Paul Ko Yiu-shum. What makes him different is that he is a private doctor, working full time at the hospital for no pay. He abandoned his private clinic as soon as he learned that the hospital had been overwhelmed with Sars patients and was in need of help. The paediatrician and veteran fighter on behalf of HIV patients has moved out of his home and isolated himself from his family to avoid any risk of passing on the virus. Patients at his private clinic are collecting money to help him pay the overheads there so that he will have a business to return to once Sars has been defeated. Dr Ko is convinced he has made the right decision. Indeed, he regards this opportunity to help as a privilege. He is reinforced in this belief every time he looks at one of his suffering young patients. The Sars outbreak in Hong Kong has killed 179 people. The disease has shattered families, leaving orphans facing an uncertain future. More than 100 children have come down with the disease; at least 24 of them have lost one parent or both. Some private doctors have shunned Sars patients, fearing they will catch the disease. But Dr Ko has, for the past month, dedicated himself to their care. He has temporarily closed his clinic at Lok Wah Estate in Ngau Tau Kok, near the Amoy Gardens housing estate where more than 300 residents have been infected. Dr Ko is now a volunteer member of Princess Margaret Hospital's paediatric team. In his 30 years in practice, he has become used to treating patients who have been stigmatised and discriminated against by society - Aids victims, the mentally handicapped, and now Sars patients. He helped to set up the Society of Aids Care in 1992 and is now a medical consultant to the Society for the Homes for the Mentally Handicapped, which has 20 homes in Hong Kong. 'History repeats itself,'' Dr Ko said. 'I saw this [Sars] as being very much like Aids when it first started in Hong Kong. Aids frightened people, and medical staff were not happy about having to take care of patients. Funeral parlours did not accept them [Aids patients] in those days. The same old picture is presenting itself now.'' In the early 1980s, more than 60 haemophiliac children contracted HIV after using contaminated blood products. Dr Ko, then a lecturer at the University of Hong Kong, treated some of them at Queen Mary Hospital. He continued to treat the Aids victims when he started his private practice in 1983. At the time, most private doctors were reluctant to treat those infected with HIV, fearing that doing so would scare away other patients and ruin their business. In his book Silent Petition, Dr Ko tells how a mother of two boys, both haemophiliacs suffering from Aids, battled with the disease and campaigned for financial help for all affected families. Now he has pitched himself into the battle against Sars. Worrying that he could become infected, he has avoided meeting his family since mid-March. Dr Ko first treated a Sars patient, a 21-year-old mentally handicapped man receiving day care at the Society for the Homes of the Mentally Handicapped, in early April. The man lives in Amoy Gardens with his parents. All three were infected and admitted to Princess Margaret Hospital. 'The hospital is ... overwhelmed with patients. I feel there is a need at the hospital for volunteers,'' he said. His offer of voluntary work at the hospital was warmly welcomed. He joined the team on April 7 and was appointed an honorary consultant, a job that in different circumstances could have earned him $200,000 a month. The head of the hospital's paediatrics department, Chiu Man-chun, said he appreciated Dr Ko's contribution to the team and said it had helped to boost morale. Dr Ko said: 'It is my privilege to work with such a good team. They know that they have someone from the outside who cares. They are not alone. Apart from that, I am an outsider and can look at things in an objective way. The medical team has given a new meaning to the word Sars - sacrifice, ability, responsibility and service. Princess Margaret Hospital has been treating 130 young patients. Dr Ko said it was unfortunate that the children have to be isolated from their parents. 'They cry all the time. We have to isolate them - some of them are Sars cases but some are suspected cases, we don't want to mix them together. It's really sad to see this happen. 'I remember in the old days, hospitals only allowed two-hour visits for children even if they were very sick. We fought very hard for parents to be able to stay with the children in the early 1980s. Now we let the children play a little bit and give them telephones to talk to their parents. Some are adjusting quickly. We draw an imaginary line and say you cannot come out from there. They don't, but just stand there, crying and asking for something.'' Three babies have been born prematurely after their mothers contracted Sars. Two of the mothers died. Two babies are staying at Prince of Wales Hospital and one at Princess Margaret Hospital. Born aged 27 to 31 weeks, the premature babies weighed only 1kg. 'There are so many tubes on the babies, and even taking 1cc of blood out of them will mean a lot to them,'' Dr Ko said. Fortunately, Sars seems to be less serious among child patients. Staff are concerned about infection control measures. They wash their hands and put on new protective gowns every time they switch from one patient to another. It takes 10 to 15 minutes to finish all the procedures. 'We just sweat like mad. We wear masks which are really airtight, we cannot smell anything,'' Dr Ko said. Some doctors and nurses have complained about inadequate protection at work. They also said their supervisors were insensitive to their demands. But Dr Ko disagreed. 'The middle management at the hospital is trying really hard to protect the staff and make them happy, as safe as possible. Most of the senior people here would be really heartbroken to see their juniors get Sars.'' His patients, some with Aids, are supportive of his work for the Sars children at hospital. They have pledged $400,000 in donations for Dr Ko. 'I told them I don't need the money now. Perhaps the money can be used on research to reduce infections among medical staff,'' he said. Dr Ko returns to his clinic every night to do research and answer patients' questions. It is also a time when he can enjoy food and soup prepared by his nurses and patients. A patient's mother often brings him his favourite ginger and eggs. Dr Ko knows the battle against Sars will be long and difficult, just like the one against HIV. 'We still know too little about Sars. For Aids, it took two years before they knew the virus, another three years to come out with a good diagnostic test. It took more than 10 years to develop the cocktail therapy. Vaccines are still at the preliminary stage of clinical trial.'' He warned that too much pressure from the government and the media on health-care management to find a solution would have adverse effects. Dr Ko said the world should learn from the swine flu outbreak in the United States in 1976. At that time, swine flu was believed to be a form of the flu that killed tens of millions of people worldwide in 1918 and 1919. Then-US president Gerald Ford announced that he was asking Congress 'to inoculate every man, woman and child in the United States' against swine flu. The programme was aborted nine months later after people given the swine flu vaccine were found to have an increased risk of developing Guillain-Barre syndrome, a rare, usually reversible but occasionally fatal form of paralysis. About 45 million people were immunised. The US government has paid out US$90 million (HK$702 million) in damages to people who developed Guillain-Barre. 'If there is too much pressure, they will just do the wrong things, just like the vaccine for swine flu in 1976,'' Dr Ko said. His next mission is to write a book about Sars. 'I want people to understand more about Sars, so they will not be so scared. We may have to learn to live with it.'' When asked why he makes such sacrifices for Aids and Sars patients, Dr Ko borrowed a line from the late US president John Kennedy. 'Ask not what your country can do for you; ask what you can do for your country.'
